Archived: The Birches

The Birches is a residential home which provides care to older people including some people who are living with dementia. The Birches is registered to provide care for up to 19 people. At the time of our inspection there were 11 people using the service.

The Birches is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Our last comprehensive inspection of this service was carried out on 21 November 2017. Two breaches of the legal requirements were found and we issued a warning notice. We rated the service as Requires Improvement. We asked the provider to submit an action plan but they did not submit one. You can read the report from our last comprehensive inspection by selecting 'all reports' link for The Birches on our website at www.cqc.org.uk.

We undertook a focussed inspection on 27 March 2018 to check that the provider met the legal requirements. We found two continued breaches of the legal requirements. We issued a Notice of Proposal to impose positive conditions on the provider, placed the service in special measures and rated the service as Inadequate. We asked the provider to submit an action plan but they did not submit one.

Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

At this inspection, we found the provider had not made significant improvements and the rating remained Inadequate.

People's safety was being compromised in a number of areas. People were not protected from the risks of the spread of infection in the service. The provider had not ensured sufficient numbers of suitably competent, skilled and knowledgeable staff were available to keep people safe and meet their needs. The provider had not followed safe recruitment procedures for all staff working in the service.

Risks associated with the premises had not been effectively assessed or monitored. The provider had not taken action to address priority concerns from fire and electrical reports, which placed people and staff at risk in the event of a fire. Maintenance was not provided in a timely manner to ensure the premises were safe and fit for their intended purpose.

Risks associated with people's health conditions and care were not consistently reviewed and care plans did not reflect people's current needs. Risk assessments lacked accurate, detailed information regarding the measures staff needed to take to keep people safe. Falls and incidents were not analysed or monitored to prevent the risk of further harm for people.

Safe systems were not consistently in place to ensure people received their medicines as prescribed. there were insufficient numbers of staff employed who had completed the necessary training to administer medicines. Medicine errors were not identified or reported in a timely manner.

The service was not well led. The provider had not adequately monitored the service to ensure it was safe and they had not identified the areas of concern that we found during our inspection. The provider had not made adequate arrangements to ensure effective leadership and governance or oversee the day-to-day running of the service in the absence of a manager.

The provider had not made the significant improvements required since our last inspection to meet the requirements of the regulations and to keep people safe from harm.

We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The Birches is a residential home which provides care to older people including some people who are living with dementia. The Birches is registered to provide care for up to 19 people. At the time of our inspection there were nine people living at the home.

The Birches is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

We carried out an unannounced comprehensive inspection of this service on 21 November 2018. Breaches of legal requirements were found. After the comprehensive inspection, the provider did not write to us to say what they would do to meet legal requirements in relation to the breaches. We inspected the service against two of the five questions we ask about services: ‘Is the service Safe?’ and ‘Is the service Well Led?’ This is because the service was not meeting some legal requirements in these areas.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our previous inspection of this service on the 21 November 2017 we found that the medicines system was not safe as staff had failed to ensure allergy information was up to date, and staff were administering a medicine to a person that they were allergic to. The policy for medicines administration had not been updated to include any information on how staff systematically audit the system to ensure it was operated safely. There was no evidence the storage temperatures of medicines were recorded regularly.

There were also issues around infection control, and an unsafe environment as electrical work had to be undertaken to ensure the environment was safe. We found the decoration of some parts of the home was poor and a frayed carpet was a trip hazard.

These were all breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment.

We also found that the service had not ensured that people's health and welfare needs were protected and promoted as good governance systems were not comprehensively in place. This was a breach of Regulation 17 HSCA RA Regulations 2014 Good governance.

We undertook this focused inspection to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Birches on our website at www.cqc.org.uk.

At this inspection we found the provider had made some changes, but overall there was little improvement in the overall safety or governance of the home and the provider continued to be in breach of the regulations of the Health and Social Care Act 2008.

We found there was a continued lack of oversight by the provider to check that quality monitoring had been carried out effectively. The quality monitoring systems included reviews of people’s care plans, food temperature checks and checks on medicines management. These checks and systems were still not reviewed by the provider to ensure people received a good, safe quality of service. Accidents, incidents and falls continued to be recorded but were still not analysed to reduce the likelihood of further incidents from happening.

Safety audits continued to be undertaken by staff, which was also demonstrated at our last inspection. The shortfalls we saw at that time, had not been improved upon, which mean that audits fell short of covering all the areas necessary to ensure people’s safety in the home. For example audits of the medicine system had not revealed the information that people’s allergies differed from the care plan and the information in the medicines administration file. Where people had medicines prescribed on a PRN or ‘as required’ basis, recording of when these had been administered was not in place.

The potential for cross contamination or cross infection in the home had not been reduced. We found areas could still not be disinfected properly, and the storage of equipment encouraged the transfer of infection. These issues became apparent as the provider had not produced procedures to ensure they knew what the processes included from beginning to end. Similarly there was no process or procedures to ensure audits were comprehensive and covered all areas to ensure people were safe in the home.

Some areas of the environment had improved and most of the electrical issues had been completed, the frayed carpet had been replaced, and the corridor walls had been painted. We found there were further issues around the safety of fire and evacuation procedures where a recent inspection had raised concerns with the basement area, where detectors were required and not in place.

There were a number of bedrooms and bathrooms that were not being used and we could not find any evidence where the water systems were maintained to reduce the potential for legionella growth.

People had fallen in the home, but there had been no falls audit to investigate the circumstances to see if patterns emerged. Checks on the first aid boxes had not been done which meant they could not be relied on in an emergency to provide staff with first aid items.

The provider had not ensured good governance systems had improved and these remain ineffective.

We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The inspection took place on 21 November 2017 and was unannounced.

The Birches is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Birches accommodates up to 19 people in one adapted building. At the time of our inspection there were 15 people living at the home.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This is a first rating inspection since the home was registered by the new provider in April 2017.

We found there was a lack of oversight by the provider’s representative to check quality monitoring had been carried out effectively. The quality monitoring systems included reviews of people’s care plans, food temperature checks and checks on medicines management. These checks and systems were not reviewed by the nominated individual to ensure people received a quality of service. Accidents, incidents and falls were recorded but not analysed to prevent further incidents from happening. Improvements were required in assessing risks to people and how staffing levels were determined to ensure safe levels of care were maintained to a standard that supported people’s health and welfare.

The nominated individual did not have effective systems in place to assess, monitor and improve the quality of care. There was no system in place by the nominated individual to supervise or oversee the staff and how they ensured people were safe in the home.

Health and safety checks were not regularly completed to ensure risks to people’s safety were minimised. We identified some health and safety issues to the nominated individual on the day of our inspection visit where we had immediate concerns to people’s safety.

The administration of medicines was not consistently secure and written instructions to ensure medicines were given accurately were not always in place.

Care plans provided information for staff that identified people’s support needs and associated risks. However, care plans and risk assessments required information to be updated to ensure staff provided consistent support that met people’s changing needs.

There were enough staff on duty to respond to people’s health needs and to keep people safe and protected from risk. However there was no dependency tool in place to establish safe staffing levels.

Staff recruitment procedures was adequate which ensured people were cared for by staff who had been assessed as safe to work with people.

People were not supported in line with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s capacity had been assessed but further improvements were required to ensure these were updated and reflected people’s capacity. One person had a DoLS in place at the time of our inspection.

Staff knew how to keep people safe from the risk of abuse. People told us they felt safe living at The Birches and visiting relatives felt their family members were safe and protected from abuse.

People felt cared for by a caring and compassionate staff group who understood people’s needs, abilities and allergies. Staff told us they had been trained, but we could not identify when this had taken place, as there was no record of training updates in place. We asked the nominated individual for a copy of this but it was not forwarded following the inspection.

People said staff provided the care they needed. Care was planned to meet people’s individual needs and abilities. Care plans were not regularly reviewed and information required to be updated to ensure staff had the correct documentary information to support people as their needs changed.

People were provided with meals that met their cultural and dietary needs. Health professional advice was sought for all those at risk of malnutrition and dehydration. Staff ensured people obtained advice and support from health professionals to maintain and improve their health.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.